RESEARCH UPDATE REVIEW
Youth Suicide Risk and Preventive Interventions: A Review of the Past 10 Years

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ABSTRACT

Objective

To review critically the past 10 years of research on youth suicide.

Method

Research literature on youth suicide was reviewed following a systematic search of PsycINFO and Medline. The search for school-based suicide prevention programs was expanded using two education databases:ERIC and Education Full Text. Finally, manual reviews of articles’ reference lists identified additional studies. The review focuses on epidemiology, risk factors, prevention strategies, and treatment protocols.

Results

There has been a dramatic decrease in the youth suicide rate during the past decade. Although a number of factors have been posited for the decline, one of the more plausible ones appears to be the increase in antidepressants being prescribed for adolescents during this period. Youth psychiatric disorder, a family history of suicide and psychopathology, stressful life events, and access to firearms are key risk factors for youth suicide. Exciting new findings have emerged on the biology of suicide in adults, but, while encouraging, these are yet to be replicated in youths. Promising prevention strategies, including school-based skills training for students, screening for at-risk youths, education of primary care physicians, media education, and lethal-means restriction, need continuing evaluation studies. Dialectical behavior therapy, cognitive-behavioral therapy, and treatment with antidepressants have been identified as promising treatments but have not yet been tested in a randomized clinical trial of youth suicide.

Conclusions

While tremendous strides have been made in our understanding of who is at risk for suicide, it is incumbent upon future research efforts to focus on the development and evaluation of empirically based suicide prevention and treatment protocols.

Section snippets

OVERALL RATES AND SECULAR PATTERNS

Suicide was the third leading cause of death among 10- to 14-year-olds and 15- to 19-year-olds in the United States in 2000 (Anderson, 2002). While the rates of completed suicide are low (1.5 per 100,000 among 10- to 14-year-olds and 8.2 per 100,000 among 15- to 19-year-olds), when nonlethal suicidal behavior and ideation are taken into account, the magnitude of the problem becomes obvious. The surge of general population studies of suicide attempts and ideation has yielded reliable estimates

Psychopathology

More than 90% of youth suicides have had at least one major psychiatric disorder, although younger adolescent suicide victims have lower rates of psychopathology, averaging around 60% (Beautrais, 2001;Brent et al., 1999;Groholt et al., 1998;Shaffer et al., 1996). Depressive disorders are consistently the most prevalent disorders among adolescent suicide victims, ranging from 49% to 64% (Brent et al., 1993a;Marttunen et al., 1991;Shaffer et al., 1996). The increased risk of suicide (odds ratios)

Family Cohesion

Family cohesion has been reported as a protective factor for suicidal behavior among adolescents in a longitudinal study of middle school students (McKeown et al., 1998) and cross-sectional community studies of high school (Rubenstein et al., 1989, Rubenstein et al., 1998) and college students (Zhang and Jin, 1996). Students who described family life in terms of a high degree of mutual involvement, shared interests, and emotional support were 3.5 to 5.5 times less likely to be suicidal than

PREVENTION STRATEGIES

Youth suicide prevention strategies have primarily been implemented within three domains—school, community, and health-care systems—and generally have one of two general goals: case finding with accompanying referral and treatment or risk factor reduction (CDC, 1994;Gould and Kramer, 2001).

TREATMENT

Recent reviews (e.g., Hawton et al., 1998, Hawton et al., 2002;Rudd, 2000) note that few studies have systematically evaluated interventions aimed at reducing suicidal ideation and behavior in children and adolescents, i.e., randomized controlled trials that obtain reliable and valid measures of outcome variables during pretreatment, posttreatment, and follow-up periods. Most treatment efficacy studies of adolescent psychiatric populations exclude suicidal individuals, possibly because the

CONCLUSIONS

The past decade has witnessed a surge in research on youth suicide risk. The current review has underscored youth psychiatric disorder, a family history of suicide and psychopathology, stressful life events, and access to firearms as key risk factors for youth suicide. Exciting new findings have emerged on the biology of suicide in adults, but, while encouraging, these are yet to be replicated in youths. Factors that had been previously thought to be risks for youth suicide, such as divorce and

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    The expert assistance of Margaret Lamm in the preparation of this manuscript is gratefully acknowledged.

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